Active NPI
Audrey Ruth Wagner, P.T.
- Physical Therapist
- Bethlehem, PA
National Provider Identifier
1699876755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT018357
- Practice address
- 2775 Schoenersville Rd
Bethlehem, PA 18017-7307 - Phone
- (610) 861-8080
- Fax
- (610) 807-0366
- NPI assigned
- Sep 25, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT018357 | PA | Primary |
Addresses
Primary practice location
2775 Schoenersville Rd
Bethlehem, PA 18017-7307
Mailing address
2775 Schoenersville Rd
Bethlehem, PA 18017-7307
Phone (610) 861-8080
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1897408 | Other | HIGHMARK BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT018357 | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187568000000",
"number": "1699876755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2775 SCHOENERSVILLE RD",
"city": "BETHLEHEM",
"state": "PA",
"postal_code": "180177307",
"telephone_number": "610-861-8080",
"fax_number": "610-807-0366"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2775 SCHOENERSVILLE RD",
"city": "BETHLEHEM",
"state": "PA",
"postal_code": "180177307",
"telephone_number": "610-861-8080",
"fax_number": "610-807-0366"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "AUDREY",
"middle_name": "RUTH",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-25",
"last_updated": "2007-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT018357",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK BLUE SHIELD",
"identifier": "1897408",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Bethlehem, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.